Superficial Basal cell carcinoma

From dermoscopedia

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 Editor: Ashfaq A. Marghoob

 Author(s): Ashfaq A. Marghoob
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The basaloid tumor islands in superficial basal cell carcinoma (sBCC) extend from the epidermis into the papillary dermis [1][2][3]. Dermoscopy can predict the diagnosis of sBCC with a sensitivity of 81.9% and specificity of 81.8% [4].

Features predictive of superficial BCC[edit]

The features predictive of superficial BCC with odds ratios ranging between 2.7 and 7.7 include [5][6][4][7][8][9][10][11][12][13][14]:

1. Leaf-like structures

2. Spoke wheel-like structures

3. Concentric structures/globules (variant of spoke wheel like structures)

Concentric structure on the upper left side of the lesion



4. Brown dots – correspond to small pigmented BCC tumor islands located at the dermal-epidermal junction. Similar size pigmented BCC tumor islands in the papillary dermis appear as blue-gray dots/globules.

Brown dots, blue gray dots.jpg



5. Short fine superficial telangiectasia

Short fine telangiectasia.jpg


6. Multiple small erosions

7. Shiny white blotches and strands. It is not uncommon for sBCC to only reveal shiny white blotches and strands with or without short fine superficial telangiectasia.

Shiny white blotches and strands.jpg

Features predictive against superficial BCC[edit]

Features predictive against the diagnosis of sBCC include [4]:

1. arborizing vessels (negative odds ratio 2.1)

2. blue-gray ovoid nest/s (negative odds ratio 3.2)

3. ulceration (negative odds ratio 2.1)

Additional features[edit]

Features that may be seen in sBCC but that are not predictive for or against the diagnosis of sBCC include multiple non-aggregated blue-gray globules and multiple in-focus blue-gray dots, which often present in a buckshot scatter distribution [4].

Heavily pigmented sBCC can sometimes mimic melanoma [15]. In such lesions the leaf-like or spoke wheel-like structures can resemble streaks (i.e., radial streaming and pseudopods) and the blue-gray globules can take on brown to black colors making it virtually impossible to differentiate these sBCC from melanoma [15][16]



References:

  1. Tabanlıoğlu Onan et al.: Correlation between the dermatoscopic and histopathological features of pigmented basal cell carcinoma. J Eur Acad Dermatol Venereol 2010;24:1317-25. PMID: 20337825. DOI.
  2. Stephens et al.: Spoke wheel-like structures in superficial basal cell carcinoma: a correlation between dermoscopy, histopathology, and reflective confocal microscopy. J. Am. Acad. Dermatol. 2013;69:e219-21. PMID: 24124839. DOI.
  3. Hirofuji et al.: Superficial type of multiple Basal cell carcinomas: detailed comparative study of its dermoscopic and histopathological findings. J Skin Cancer 2011;2011:385465. PMID: 21151508. DOI.
  4. 4.04.14.24.3 Lallas et al.: Accuracy of dermoscopic criteria for discriminating superficial from other subtypes of basal cell carcinoma. J. Am. Acad. Dermatol. 2014;70:303-11. PMID: 24268311. DOI.
  5. Khokhar: Growling, flushing, and a 30-pound weight loss. Hosp. Pract. (Off. Ed.) 1985;20:64-5. PMID: 2411744.
  6. Suppa et al.: Dermoscopic variability of basal cell carcinoma according to clinical type and anatomic location. J Eur Acad Dermatol Venereol 2015;29:1732-41. PMID: 25627865. DOI.
  7. Emiroglu et al.: The relation between dermoscopy and histopathology of basal cell carcinoma. An Bras Dermatol 2015;90:351-6. PMID: 26131865. DOI.
  8. Giacomel & Zalaudek: Dermoscopy of superficial basal cell carcinoma. Dermatol Surg 2005;31:1710-3. PMID: 16336893.
  9. Popadić: Dermoscopic features in different morphologic types of basal cell carcinoma. Dermatol Surg 2014;40:725-32. PMID: 25111343. DOI.
  10. Trigoni et al.: Dermoscopic features in the diagnosis of different types of basal cell carcinoma: a prospective analysis. Hippokratia 2012;16:29-34. PMID: 23930054.
  11. Pan et al.: Dermatoscopy aids in the diagnosis of the solitary red scaly patch or plaque-features distinguishing superficial basal cell carcinoma, intraepidermal carcinoma, and psoriasis. J. Am. Acad. Dermatol. 2008;59:268-74. PMID: 18550207. DOI.
  12. Ahnlide et al.: Preoperative prediction of histopathological outcome in basal cell carcinoma: flat surface and multiple small erosions predict superficial basal cell carcinoma in lighter skin types. Br. J. Dermatol. 2016;175:751-61. PMID: 26921200. DOI.
  13. Micantonio et al.: Vascular patterns in basal cell carcinoma. J Eur Acad Dermatol Venereol 2011;25:358-61. PMID: 20561131. DOI.
  14. Puig et al.: Dermoscopic criteria and basal cell carcinoma. G Ital Dermatol Venereol 2012;147:135-40. PMID: 22481576.
  15. 15.015.1 Altamura et al.: Dermatoscopy of basal cell carcinoma: morphologic variability of global and local features and accuracy of diagnosis. J. Am. Acad. Dermatol. 2010;62:67-75. PMID: 19828209. DOI.
  16. Bakos et al.: Radial streaking: unusual dermoscopic pattern in pigmented superficial basal cell carcinoma. J Eur Acad Dermatol Venereol 2007;21:1263-5. PMID: 17894724. DOI.